Permit CITY OF TIGARD MECHANICAL PERMIT
11 4 a : COMMUNITY DEVELOPMENT Permit #: MEC2009 -00501
TIGARD 13125 SW Hail Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
Parcel: 1 S133DA08600
Jurisdiction: Tigard
Site address: 12617 SW SNOWBRUSH CT
Subdivision: Lot: 0
Project: Jones
Project Description: Install furnace.
Owner: FEES
JONES, KENNETH A & Description Date Amount
WESTERSUND, ANDREA I, 12617 SW
SNOWBRUSH CT Furnaces < 100K BTU 09/23/2009 $14.00
12% State Surcharge - Mechanical 09/23/2009 $8.70
PHONE: 503 - 579 -6130 Minimum Fee Adjustment - Mechanical 09/23/2009 $58.50
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115
PHONE: 503 - 691 -9699
FAX: 503 - 691 -8556
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue: •
•
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ' cation Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or d' ct questions to OUNC .y calling 50 .246.6699 or 1.800.332.2344. ,
I ued By: Vii 14 Permittee Si � ; J�''
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
t
Mechanical Permit Application • Foil OFFICE USE ONLY . •
•
City of Tigard CEIVED rtm 9 Q a o9 I5 ! Permit No.: t o , ,D9 OD,�b/
e 1 3125 S W Hall Blvd., Tigard OR 97 Plan Review
Phone: 503.639.4171 Pax: 503.598.1960 c � x100 Date/By: Other Fan nit
T I G AR D
Inspection Line 503 SEP u L Aare Ready/6y: El See Page 2 ter
Internet Www.tigard - or.gov � , ,,..1 Notified/Method: PM Supplemental Information
. r IF
f ,:7.., ;. s , p it :
. , y . . yy ..
.b.:: ' .6,..I ;- 31 ; ? . d ... ! , a -':1: i 9L : ',91 F' .k> L . > }. . •� L' .,� •,.._.. .".'
.
.,.,... 1 ..,.. .:.:...:....r..:... , .5.... .11 _.!I.�. ....:. � NP: ..,. .'�..�.. ('��'•_ \. .. I�.f ..., _.. I'lf �_/,Y _�•,p�tn,�.Y.T��• e , V� �/. -�r �.�. .T .1.
Mechanical permit fees* a based on the value of the work
❑ New construction ddition/altaation/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other, mechanical materials, equipment, labor, overhead, and profit.
:•t.�'}a „4: "• '':t` - ':�•T' :,;' ' dJ:,:,l _ ;.,�, Value: S
t. : lr, e.:.... i` (>A3`,.. - ' ; ''U>r:'SA S`»itxrCl`�b ..,':; ' t:, ..ir
r.'id Yi,, ,... ..,.. .,.,,.c,......,.' . ..... .. ........�:1, ,..•'?;;i'r? Jr:, .I ,.,: , a.,.,., r: "::
,r +:
r.
- X 1- and2- family dwelling ❑Commercial/industrial ❑Accessory building ; "!i' .,14''c: :,. .: }' :'.,r:P:
❑ Multi - family 0 Master builder ❑ Other For special information use checklist.
Description Qty. I Fa. Total
rt gtit? ; 3 �:�'• �:F PIN:JOB Sfl E „'i ONi A�1D"' TrON : 1;'' �b�:
;.;jS:,:t: �
t7t,,: J.. !,.i..,�.p,.ail:,..._:..r <,.:.. .,. „r;' .....:...... ..' X ._...,:,..,... ?, r P!' .r .,._ ` i;; Ready/cooling
-
Job site address: tar2 11 ELO aerrx C ~ Air conditioning or heat pump -
(feQUires Site plan showing plapeIDent) ]4.00
City /State /ZIP: . - 1 - 1 co ,Q g PUIYlace 100,000 BTU (duetc/venu) ' 14.00 •
A Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt no.: Project name: Gas heat pump 14.00 •
Cross street/directions to job site: Duct wok 10.00
' Hydronia hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (litel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: (Lot Plue/veat for any of above 6.80 .
Other. 10.00
T ax map /parcel no.: Other fuel a • • llancea
Si iri` T ,?l�il j1rr"1 1a�+?"i:� �tta�'" 'I e 73 „ "• l3f ll IPME I I f Water beater 10,00
i at f
/ �, tU?i)t ;:A !'iltsh M -?n
, Gas fireplace 10.00
1[�l_ �1 ( 1� �.� ... - Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) _ 10.00
Wood/pellet stove 10.00
• . Wood fireplace/insert 10 -00
r �. p r. �� �, Itr q 33• Chimney/liner/flue 10.00
� i ,.P i. ,,1,,. .,•,. .e14 "��rJ 1.'Gtttia� fiL� aCJ1�,•.V� az , (� V t. L. .
Other _ 10.00
Name: (Lom) ,S Environmental exhaust and ventilation.
Address: 15 - i � e equ Range hood/other kitchen
equpment 10,00
Ci /StatefZJP: C
` IG�. t `7 93..7-3 Clothes er exhaust 10.00
Single exhaust (bathrooms,
Phone: a ��q o Fax: ( ) toilet compartments, utility rooms) 6.80
" tt �.V .. it l + -•.r 1 - + r :• °•.r..:.. y ': r " .
4- S . 'I iN {'i i,u Y, ';1' 1pp17� a' ij c,0,1 t, 1� - .4�•'
_ ,.,01,',�t.t /.�is♦�r�iriier�i�•: �r .,����:ptY^lf`•�,��:cSit,r��:. dui' 1; �, �ctu'.!' �!��,.r'r•,a +fc; ' ..:..� ��:i',i•?ip Attic/crawlspaoefans • 1000 • - Other _ Fuel 10.00
Business amend.
N t1 � C. Fuel piping
Contact name: kj ( r.) , $5.40 for Grst four; $1.00 for each additional
Address: x t f 1 Furnace, etc
Gas heat pump .
city/SIme IP: 1 ) � O fl Wall/suspended/unit heater
(C t c_pl. + - GI 6 q C7 V.)
FM" ( ) 6 C3 L 1Cr 1 - 8 ' water beater
E-mail: Fireplace •
• t, .' ,; , !'A t, ` fi' :�,M''I' r ?:;f : ' , ;i i I`_;y �' � . '• r
''r' i ' r. . '.i ` a, i ;, `' ; :iiii B
I<;.: , n :11∎ .y∎ { k ':
' rl 9 d :s 0t.: I., J ,r .; ' t . r ..:i ti. sIu: , Barbecue
u :;p.l . Zt r..il ' w e.��. ,� :� ` :� .11�t . �,. 1 � '7� ` • i :. .i sfi'r 4d..r. _ v. - 1'ir�.:itw:..,r.:..,;ti; �'cr
B usiness name ( . .. � ( �n C 4 A C. Clothes dryer ()!as)
� Other.
tom,,.,,` I ': `t i4 "�' 1 a ry a•,... yT _,,..
Address: i x 1x Q4 1 `'rui� r !!��') . �t �4: �.f[f[•__ � ,',,,' l db _ ___
Q � :�:CA�nI' I I.:(..il',:(Yl:r 5-.. �?7,.�'E,.'�lrlll:y . �:
City /state/ZIP: v)u.nf'kee -6� ' `) Subtotal
Minimum permit fee ($72.50) 1,2
Phone: \- q 6c Fax: (50, e 1- 55 Plan review (25% ofpermit fee)
CCB lic.: S a 1 a (� State surcharge (12% ofpermit fee) 48. a
V TOTAL PERMIT FEE 2 ( , �o
Authorized signature:
ill, , \ This permit application expires if a permit Is not obtain within 180
(Ilya after it 1 bee° accepted as complete
Print name if IL i j I i . . VLj J Date: `�r �C � Q • 1 ` Fee methodology set by Tel -County Building Industry Service Board
lat alidiaelPemrirs \MEC- PetmlrApp,doc 01/19/D7 440.4617T 01 21COM/NEB)
ZO /ZO 39dd 9NI203H NO932i0 9558- t69 -EOS Zb:OT 6002/ZZ/60